Correspondence
Histamine Release in Chronic Idiopathic Urticaria
N Engl J Med 1993; 329:1583November 18, 1993
- Article
To the Editor:
In their article describing autoantibodies against the high-affinity IgE receptor as a cause of histamine release in chronic urticaria, Hide et al. (June 3 issue)1 state that the majority of patients with severe, chronic urticaria have an immediate wheal-and-flare response after intradermal injection of autologous serum. Have the authors investigated this phenomenon in patients with acute hives? If so, is chronic urticaria more likely to develop in patients with a positive reaction to their own serum? One of my patients with acute hives of unknown cause had a positive result on skin testing with autologous serum. When skin testing was repeated four weeks later, the results were still positive, even though her acute hives had disappeared within a few days and she had not taken medications for three weeks.
1 ReferencesWilliam M. Hendricks, M.D.
Asheboro Dermatology Clinic, Asheboro, NC 272031
Hide M ,Francis DM ,Grattan CEH ,Hakimi J ,Kochan JP ,Greaves MW . Autoantibodies against the high-affinity IgE receptor as a cause of histamine release in chronic urticaria. N Engl J Med 1993;328:1599-1604
Full Text | Web of Science | Medline
Author/Editor Response
The authors reply:
To the Editor: Dr. Hendricks's observations are not unexpected. Two of our patients with acute recurrent urticaria of three and seven weeks' duration had positive results on autologous-serum skin testing. Both patients had urticarial activity for more than two months before entering clinical remission. Although it is often assumed that acute urticaria is mediated by mast-cell degranulation through the cross-linking of allergen-specific IgE, it is clear that acute urticaria may merge into chronic urticaria and that the duration of disease is of little value in defining pathogenesis. Patients with a wheal response after the injection of autologous serum had negative results when tested with fresh autologous serum during clinical remission one year later1. In contrast, patients in temporary clinical remission after plasmapheresis did not completely lose their reactivity to fresh serum, even though there was a two-thirds reduction in serum IgG2. The skin-test reactivity observed by Dr. Hendricks in his patient four weeks after her acute hives had disappeared suggests that she may be prone to relapse and, furthermore, that local neurovascular factors may determine whether autoantibodies cross capillary endothelial membranes to initiate degranulation by binding cutaneous mast-cell receptors. This interpretation is supported by the presence of persistent basophilic leukopenia during clinical remission in some patients with urticaria3.
3 ReferencesClive E.H. Grattan, M.R.C.P.
Michihiro Hide, M.D., Ph.D.
Malcolm W. Greaves, M.D., Ph.D., F.R.C.P.
St. John's Institute of Dermatology, St. Thomas's Hospital, London SE1 7EH, United Kingdom1
Grattan CEH ,Wallington TB ,Warin RP ,Kennedy CTC ,Bradfield JW . A serological mediator in chronic idiopathic urticaria -- a clinical, immunological and histological evaluation. Br J Dermatol 1986;114:583-590
CrossRef | Web of Science | Medline2
Grattan DEH ,Francis DM ,Slater NGP ,Barlow RJ ,Greaves MW . Plasmapheresis for severe, unremitting, chronic urticaria. Lancet 1992;339:1078-1080
CrossRef | Web of Science | Medline3
Rorsman H . Basophilic leucopenia in different forms of urticaria. Acta Allergol 1962;17:168-184
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